Provider Demographics
NPI:1942715180
Name:KIM, JAEKEUN (MD, PHD, FACS)
Entity Type:Individual
Prefix:DR
First Name:JAEKEUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, PHD, FACS
Other - Prefix:DR
Other - First Name:JAE
Other - Middle Name:KEUN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD, FACS
Mailing Address - Street 1:101 MONMOUTH ST APT 414
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5612
Mailing Address - Country:US
Mailing Address - Phone:617-935-3261
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0002
Practice Address - Country:US
Practice Address - Phone:216-444-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283842204F00000X
MA273758390200000X
OH35.145723204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program